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( Vikas Asatl ),( Girish Bhageshwar Ramteke ),( Vinatak Jatale ),( Vep Prakash Pandey ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
The Chiari I malformation (CMI) is caudal displacement of cerebellar tonsils into cervical spinal-canal. CMI is defi ned by tonsillar herniation more than 5 mm below foramen-magnum, may be congenital or acquired. We are presenting case of Arnold chiari with hemiparesis, hemisensory loss with lower cranial nerve palsy. 50 year male, complaints of tingling, numbness left LL, UL since 7 months, Weakness left LL, UL 6 months, drycough, diffi culty in swallowing, regurgitation of food, headache 3 months. Decubitus -supine position left leg extended laterally rotated, higher functions normal. Trigeminal- there is loss of all sensation modalities on left side of face, Gag refl ex is normal with normal palatal movement, Left side shoulder cannot be raised, power of tongue is slightly decreased on left, resting nystagmus with fast component toward right side. On attempting to see right side nystagmus increases while on seeing to left decreases. Heel-knee, fi nger-nose-test on right side is normal, on left side unable to do due to motor weakness. MRI Brain parenchyma normal. Inferior cerebellar tonsillar herniation in dorsal subarachnoid space extending about 6-7 mm below the posterior arch of atlas-Chiari Malformation type I, Mild indentation is seen on the dorsal surface of upper cervical cord. Minimal inferior displacement of 4th ventricle, no hydrocephalus, no syrinx. Discussion: Chiari malformations consist of varying degree of ectopia of cerebellum. Incidence in MRI is between 0.56% and 0.77%.Type I: Elongation of tonsils and medial parts of the inferior lobes of cerebellum into cone-shaped projections, which accompany medulla oblongata into spinal canal. Type II Displacement of parts of inferior vermis, pons, medulla-oblongata together with elongation of fourth ventricle (most cases with spina bifi da). Type III The entire cerebellum herniates into the cervical canal. Type IV is with Cerebellar hypoplasia.
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